Where the power lies in the therapist-client relationship

‘Surely it is the nature of the relationship that is the crux. That of analyst and patient – helper and helped – is one of power and, with power all on one side, will never work,’ writes Christine Dixon.
Photograph: PhotoAlto/Alamy

Oliver Burkeman (Therapy Wars, The long read, 7 January) falls into the trap of polarising the wrong point about contemporary psychotherapy. Like any pioneer, Freud made many assumptions that have since turned out to be self-interested, culture-specific or just wrong. But to write him off as a charlatan is facile. What he revealed on behalf of clients then and now is the immense transformative value of being listened to: of having our emotional histories taken seriously, empathically inquired about and ascribed an appropriate level of relevance in the balance of who we are and who we are capable of becoming.

I too am sceptical about the claims made for traditional psychoanalysis, with its power-base located in the “expert” interpretations of the analyst. I have encountered former analysis clients who have retrospectively come to regard their analytic experience as exploitative, even abusive. But I am no more enamoured by the idea that reducing our emotional challenges to a series of left-brain box-ticking exercises is of lasting value either. A number of my clients have reported similar reactions to those of “Rachel” in Burkeman’s article.

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Between these two poles of CBT and psychoanalysis lies a rich field of integrative theory and practice, in recent years endorsed by and increasingly informed by the findings of neuroscience. Central to these findings is the notion of relationship. Every therapy client is in some way struggling in this area, whether with self or other. From this perspective, an analyst who is capable of evoking and maintaining a client’s trust through how they approach and build the therapist-client relationship is likely to have equal success with a CBT practitioner who does the same. The problem with both schools is that they tend to major on procedural method more than they do on “relationship” – a much harder concept to quantify and pin down, and one that can rather frighteningly equalise the status of therapist and client.

Where psychotherapy enables a right-brain to right-brain reparative relationship to be created, for use by the client whose early experience has left them starved of this, I’m in no doubt that lasting positive transformation can occur. This is contemporary psychotherapy at its best. I suspect that if Freud and Jung were alive today, they would both take a similar view.Christopher MillsRelationship therapist, family mediator, family consultant, Bath

• Surely it is the nature of “the relationship” (Oliver Burkeman’s quote of Michael Balint) that is the crux. That of analyst and patient – helper and helped – is one of power and, with power all on one side, will never work. Feelings of powerlessness, and often actual powerlessness, as a constant – as is often the case in one-to-one relationships – are the root of much mental distress.

“Community” is about non-hierarchical relationships where people act and interact as equals – look at the recent flood victims. But it doesn’t need disasters to develop communities. It does need work, support, funding for people to help each other and, where people think they don’t need other people, to recognise and value community and the contribution it makes to mental health.Christine DixonLondon

• From Oliver Burkeman’s account, it looks as if cognitive behavioural therapy has a disquieting resemblance to the ethos of American self-help books like The Power of Positive Thinking, an ethos parodied in the Monty Python Song Always Look on the Bright Side of Life. I am not surprised to read that a former patient became disillusioned when she found she had to answer a tickbox questionnaire to a computer. The idea seems to be that those who have been crushed by disabling loss, feel intolerable guilt or a burning sense of injustice should be brainwashed into thinking that these feelings are purely subjective and the remedy lies in themselves. I don’t think CBT could have done anything for Lady Macbeth or for a Robert Graves racked with guilt at the Germans he had murdered (he insisted that word should be used if I remember) in the first world war.Malcolm PittockBolton

• Oliver Burkeman mentions the link between stoicism and cognitive behavioural therapy. There is another link that is equally relevant with an ancient but very much living philosophy that is also a major world religion: Buddhism. There are substantial areas of overlap between Buddhist teachings about cognition, emotion, self-control, and ethics and the ways in which CBT can be used to alleviate suffering, advance individual wellbeing and self-awareness, and contribute to improved relationships and better communication and understanding. Noam SchimmelVisiting fellow, Kellogg College, Oxford University